Kratom and Alcohol: Why Mixing Them Raises the Risk

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Mixing kratom and alcohol is riskier than using either alone. Both can depress the central nervous system, alcohol is the most common co-exposure in kratom cases reported to US poison centres, and it appeared in about one in five kratom-associated deaths from 2015 to 2025. Multi-substance kratom exposures lead to more hospital admissions and serious outcomes.1

No controlled human study has tested kratom and alcohol together, so nobody can say how much of either is “safe” in combination. What exists is poison-centre data, death investigations, liver injury case reports and pharmacology, and they point the same way: the combination adds risk, and the added risk is greatest with high doses, concentrated 7-OH products and other sedatives.

This guide covers how the two interact, what the overdose and liver data show, where hangover and withdrawal blur together, and practical harm-reduction points. If alcohol or kratom use is getting hard to control, the free, confidential SAMHSA National Helpline is on 1-800-662-4357, 24 hours a day.2

At a glance

QuestionWhat the evidence shows
Controlled human studies of the combinationNone found
Alcohol in multi-substance kratom poison-centre reports22%, the most common co-exposure (2015 to 2025)1
Ethanol in kratom-associated deaths19% of 233 deaths reported to poison centres1
Alcohol listed as a cause in kratom-positive overdose deaths12.5% in CDC data from 27 states, 2016 to 20173
Main mechanism of concernAdditive effects on the central nervous system1
LiverBoth can injure the liver; combined effect not studied4,5
Metabolic (CYP) interaction with alcoholNot demonstrated; kratom does inhibit CYP3A6

Can you mix kratom and alcohol? Why the combination raises the risk

Kratom’s main alkaloid, mitragynine, is described as stimulating at low doses and more opioid-like at higher doses.3 Its metabolite 7-hydroxymitragynine is a much stronger mu-opioid receptor agonist.7 Our overview of kratom and opioid receptor research explains the pharmacology.

Alcohol is a depressant. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says alcohol and opioids both suppress brain areas that control breathing, that taking alcohol with other drugs intensifies their effects, and that high alcohol levels can blunt the gag reflex.8 In a study NIAAA cites, oxycodone alone reduced breathing by 28%, and alcohol at a blood level of 0.1% lowered it by a further 19%.5 Alcohol is involved in about one in five overdose deaths related to prescription opioids.5

How closely kratom follows that opioid pattern depends on what is in the product:

  • Leaf and mitragynine. In a rat study using an FDA-style design, oral mitragynine did not cause significant respiratory depression even at very high doses, while oxycodone did.9 In another rat study, mitragynine increased breathing rate.10 Neither study tested alcohol, and neither proves the combination is safe in people.
  • 7-OH. The same 2025 rat study found 7-OH suppressed breathing like morphine and was 4.5 times more potent at halving minute volume.10 The DEA’s October 2026 scheduling notice calls co-use of 7-OH products with other substances, commonly a central nervous system depressant, a serious concern.11

That is why the riskiest version of kratom and alcohol is a concentrated 7-OH tablet or shot plus drinks, often with a benzodiazepine or another sedative added. Our explainer on 7-OH vs traditional kratom covers why these products behave differently from leaf.

What overdose and poison-centre data show

Most of what is known about kratom and alcohol comes from cases where something went wrong. These datasets show association, not cause, and almost all involve several substances.

  • CDC overdose deaths, 2016 to 2017. Of 27,338 overdose deaths entered into the State Unintentional Drug Overdose Reporting System, 152 tested positive for kratom. A medical examiner judged kratom a cause in 91. Fentanyl was the most common co-occurring cause, but alcohol was listed as a cause in 19 of the 152 deaths (12.5%).3
  • Poison centres, 2015 to 2025. Of 14,449 kratom exposure reports, multi-substance reports were linked to more hospital admissions (44 to 56% a year, against 24 to 29% for kratom alone) and accounted for 184 of 233 deaths. Ethanol was the leading co-exposure and appeared in 19% of the deaths. The CDC authors wrote that combining kratom with alcohol, opioids, benzodiazepines, stimulants or antidepressants might raise risk through additive effects on the central nervous system.1
  • Poison centres, 2011 to 2017. Multi-substance kratom exposures carried 2.8 times the odds of admission to a health care facility and 2.25 times the odds of a serious medical outcome.12
  • Florida death investigations. Among 111 deaths in which mitragynine was detected but not judged the cause, every case involved other substances, including ethanol in 29.13
  • International case review. In 156 kratom-associated deaths, 87% involved other substances, typically controlled drugs, medicines and alcohol.14

None of this means a drink with kratom is likely to be fatal. It does show that alcohol is a common thread in the worst outcomes.

Kratom and alcohol: the liver question

Kratom can injure the liver, although serious cases appear uncommon. The US Drug-Induced Liver Injury Network identified 11 cases attributed to kratom; all patients developed jaundice after a median of 14 days, most were hospitalised and all recovered.4 A 2020 review of 26 case reports found a median latency of about three weeks and a mostly cholestatic pattern, and concluded that kratom likely causes liver injury, while noting the evidence is low quality and that it is unclear who is most at risk.15 Our article on kratom and liver injury covers the case reports in detail.

Alcohol is a major cause of liver disease in its own right: fatty liver is present in roughly 95 to 100% of people who drink heavily, and alcohol-associated liver disease is now the leading reason for liver transplants in the US.16 Heavy drinking also increases activity of CYP2E1, a liver enzyme involved in breaking down alcohol and some medicines.5 What nobody has studied is whether kratom and alcohol together damage the liver more than either alone. Case reports attributing injury to kratom check for other causes, alcohol included; in one, doctors noted a negligible alcohol history before reaching that conclusion, and the injury returned when the patient took kratom again.17 A 2026 case report flagged that commercial kratom products may include concentrated extracts, 7-OH-enriched formulations or ethanol-based preparations, which could increase liver and interaction risk.18

Practical point: the symptoms reported in kratom liver injury include abdominal discomfort, jaundice, itching and dark urine.15 Anyone who notices them while using kratom, or who drinks heavily or has liver disease, should stop and see a doctor promptly.

Interaction mechanisms: does kratom change how alcohol is processed?

There are two kinds of drug interaction. Pharmacodynamic interactions happen when two substances act on the same body systems, such as breathing and alertness. Pharmacokinetic interactions happen when one changes how the other is absorbed or broken down. For kratom and alcohol, the first kind is the main documented concern.1

On the second kind, evidence is limited. In the only clinical study of kratom’s interaction potential, a single 2 g dose of kratom tea raised exposure to midazolam, a drug cleared by CYP3A, by about 39%, but did not affect dextromethorphan, a CYP2D6 marker.6 The authors concluded kratom mainly inhibits CYP3A in the gut. Separately, CYP3A4 is the enzyme that turns mitragynine into 7-OH in people.19 We found no study showing that kratom changes alcohol metabolism or that alcohol changes kratom levels. The study’s authors noted that many drugs used alongside kratom are cleared mainly by CYP3A or CYP2D6,6 so the interactions that matter most in practice are likely to involve medicines and other drugs taken at the same time, such as benzodiazepines, sleep aids and opioids. Our guide to kratom and drug interactions covers these.

Hangovers, withdrawal and why they get confused

Regular kratom users who stop can develop withdrawal. In a Malaysian survey of 293 regular users, common symptoms included muscle pain, poor sleep, runny nose, hot flushes, diarrhoea, restlessness, tension and low mood.20 Alcohol withdrawal shares several of these features: anxiety, sweating, insomnia, nausea, rapid heart rate and tremor, usually starting within 8 hours of the last drink and peaking at 24 to 72 hours.21

The overlap creates two problems:

  1. Misreading the cause. Someone who drinks heavily and uses kratom daily may blame a rough morning on a hangover when it is kratom withdrawal, or the reverse, and use more of one to treat the other.
  2. Missing a dangerous withdrawal. Alcohol withdrawal can become life-threatening, with seizures, hallucinations and delirium tremens.21 In a 2026 case series of people combining kava and kratom (two botanicals we compare in kratom vs kava), all four patients had alcohol use disorder, and their withdrawal resembled sedative withdrawal and needed phenobarbital or benzodiazepines.22

Some people use kratom to cut down on drinking. Mitragynine reduced alcohol self-administration in a 2026 rat study,23 and reviewers describe similar animal findings,24 but there are no human trials. No kratom product is approved for alcohol use disorder, whereas a few medicines are;24 a doctor can discuss them.

Practical harm-reduction points

The safest option is not to combine them. If you use kratom and also drink, these points reduce risk. They are not a guide to dosing.

  • Avoid using them on the same occasion, and keep in mind that mitragynine has a terminal half-life of about a day in chronic users, so it does not clear quickly.25
  • Do not add other depressants, such as benzodiazepines, sleep medicines, gabapentinoids or opioids, and avoid concentrated 7-OH products entirely when drinking.1,11
  • Never use alone, and do not drive.
  • Know the signs of overdose: confusion, being hard to wake, slow or irregular breathing and clammy skin. Call 911 straight away, do not leave the person alone, and put them on their side if they are lying down.8
  • Carry naloxone if you use 7-OH or other opioids. It reverses opioid overdose and is sold over the counter,26 but alcohol may still be part of the problem, so call 911 too.
  • Check what you are taking. Product strength varies, and our guide to why there is no official kratom dose explains what research does and does not show. New users should read our kratom guide for beginners first.
  • Tell your doctor or pharmacist about kratom, alcohol and every medicine you take.

For urgent advice about a possible reaction, Poison Help is on 1-800-222-1222.27

Frequently asked questions

Can you mix kratom and alcohol safely?

There is no evidence-based safe amount. No controlled study has tested the combination, and both can depress the central nervous system. Alcohol was the most common co-exposure in multi-substance kratom poison-centre reports and appeared in 19% of kratom-associated deaths from 2015 to 2025.1 The risk rises with higher doses, 7-OH products and other sedatives. Avoiding the combination is the safest choice.

Is kratom and alcohol bad for your liver?

Both can harm the liver on their own. Kratom has been linked to liver injury with jaundice in case reports and in a US drug-induced liver injury network, usually within a few weeks of starting, with most people recovering after stopping.4,15 Alcohol is a leading cause of liver disease.16 Whether the combination is worse has not been studied, so anyone with liver disease or heavy drinking should avoid kratom.

How long after taking kratom can you drink alcohol?

There is no research-based waiting time. Mitragynine has a terminal half-life of around a day in chronic users and longer after repeated dosing in a controlled study, so it lingers in the body well after its effects fade.25,28 Product strength also varies widely. If you choose to drink, avoiding kratom that day and not combining it with other sedatives lowers risk.

Does kratom help with hangovers or alcohol withdrawal?

There is no human evidence that it does. Mitragynine reduced alcohol self-administration in rats,23 but no clinical trial has tested kratom for hangovers or alcohol withdrawal. Alcohol withdrawal can cause seizures and delirium tremens and may need medical treatment.21 Using kratom to manage it risks masking a dangerous withdrawal and adding a second dependence.

Is 7-OH with alcohol more dangerous than kratom leaf with alcohol?

Very likely. In rats, 7-OH suppressed breathing like morphine and was more potent, while mitragynine did not depress breathing.10 The DEA’s October 2026 notice flags co-use of 7-OH products with other substances, commonly central nervous system depressants, as a serious concern.11 Combining a concentrated 7-OH product with alcohol carries the opioid-plus-alcohol risks NIAAA describes.

Sources

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This article is for educational purposes only and is not medical or legal advice. Products discussed here are not intended to diagnose, treat, cure or prevent any disease. Laws vary by location and change often, so verify the rules that apply where you are. Always talk to a licensed healthcare provider before use, especially if you are under 21, pregnant or nursing, taking medication, or managing a health condition.

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